Prevalence and associations of spectacle adherence among school children in a multicentre Indian study

Background/aims To assess adherence to spectacle wear among children attending public and private schools in urban and rural locations in Kerala, Maharashtra, Madhya Pradesh, Tamil Nadu and West Bengal. Methods All schools within a district served by one of six partner hospitals were invited to participate. Vision screening occurred in children aged 5 to 18 years using a pocket vision screener. Children unable to read 0.2 logMar letters (Snellen equivalent approximately 6/9) monocularly, able to read them through a +1.50 DS lens, already wearing spectacles or with ocular complaints or abnormalities were examined on-site by a vision professional. Glasses were provided according to age-specific guidelines and subjective improvement. Adherence was assessed by direct observation at an unannounced follow-up visit. Results Among 31 991 children prescribed glasses at 2145 schools, 29 667 (92.7%) were available at follow-up median of 5.6 months instead of a planned 3-month follow-up. Of these, 19 679 (66.3%) were adherent. Adherence was higher in children with poorer presenting vision, younger age, attending rural or government-supported schools, in areas with lower human development index or wearing spectacles for the first time (all p<0.001) but did not differ by sex (p=0.414). Adherence was higher in children with astigmatism than myopia (p<0.001) but not hyperopia (p=0.455), was similar in the latter two conditions (p=0.903) and decreased with longer follow-up intervals (p<0.05). Conclusion This large study covering a wide geographic area and variety of schools reveals higher wear among children in greatest need of free service: those living in rural, poorer areas, attending government schools and not previously owning glasses.